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Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
Published on: October 20, 2016
Strain-time curve analysis by speckle tracking echocardiography in cardiac resynchronization therapy: Insight into
Andrew C Y To1,2, Rodolfo D Benatti1, Kimi Sato1
1Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA.
Insights
Patients with non-ischemic heart failure and LBBB who did not respond to CRT had lower longitudinal strain (εlong). This reduced strain amplitude may explain their poor response to cardiac resynchronization therapy.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Management
Background:
- Patients with non-ischemic heart failure and left bundle branch block (LBBB) often respond well to cardiac resynchronization therapy (CRT).
- Despite significant left ventricular (LV) dyssynchrony in these patients, standard assessments of LV dyssynchrony do not reliably predict CRT outcomes.
- A characteristic strain distribution pattern may identify patients likely to benefit from CRT.
Purpose of the Study:
- To investigate if a specific pattern of longitudinal strain (εlong) distribution can identify patients with non-ischemic cardiomyopathy and LBBB who will respond favorably to CRT.
- To compare the echocardiographic strain patterns of CRT responders and non-responders.
Main Methods:
- Retrospective analysis of 313 patients who underwent CRT; 10 non-responders (no LV end-systolic volume [LVESV] reduction) and 10 responders (LVESV reduction ≥15%) with non-ischemic cardiomyopathy and LBBB were selected.
- Longitudinal strain (εlong) data were acquired using speckle tracking echocardiography before and after CRT (mean 9 months).
- Standardized segmental εlong-time curves were generated by averaging individual patient data.
Main Results:
- Responders showed improved ejection fraction (EF) from 25% to 40% (p=0.002), while non-responders had no significant EF change (20% to 21%, p=0.57).
- Pre-CRT global εlong was significantly lower in non-responders (p=0.02). Post-CRT, εlong improved only in responders (p=0.04).
- Both groups showed restored contraction synchrony, but non-responders maintained a low amplitude of εlong.
Conclusions:
- CRT non-responders with LBBB and non-ischemic etiology exhibited similar improvements in εlong patterns post-CRT compared to responders.
- The persistently low amplitude of εlong in non-responders may be the key factor limiting their response to CRT.
- Strain pattern analysis, particularly εlong amplitude, could offer a more refined method for predicting CRT outcomes in this patient group.
Background:
Patients with non-ischemic heart failure etiology and left bundle branch block (LBBB) show better response to cardiac resynchronization therapy (CRT). While these patients have the most pronounced left ventricular (LV) dyssynchrony, LV dyssynchrony assessment often fails to predict outcome. We hypothesized that patients with favorable outcome from CRT can be identified by a characteristic strain distribution pattern.
Methods:
From 313 patients who underwent CRT between 2003 and 2006, we identified 10 patients who were CRT non-responders (no LV end-systolic volume [LVESV] reduction) with non-ischemic cardiomyopathy and LBBB and compared with randomly selected CRT responders (n = 10; LVESV reduction ≥15%). Longitudinal strain (εlong) data were obtained by speckle tracking echocardiography before and after (9 ± 5 months) CRT implantation and standardized segmental εlong-time curves were obtained by averaging individual patients.
Results:
In responders, ejection fraction (EF) increased from 25 ± 9 to 40 ± 11% (p = 0.002), while in non-responders, EF was unchanged (20 ± 8 to 21 ± 5%, p = 0.57). Global εlong was significantly lower in non-responders at pre CRT (p = 0.02) and only improved in responders (p = 0.04) after CRT. Pre CRT septal εlong -time curves in both groups showed early septal contraction with mid-systolic decrease, while lateral εlong showed early stretch followed by vigorous mid to late contraction. Restoration of contraction synchrony was observed in both groups, though non-responder remained low amplitude of εlong.
Conclusions:
CRT non-responders with LBBB and non-ischemic etiology showed a similar improvement of εlong pattern with responders after CRT implantation, while amplitude of εlong remained unchanged. Lower εlong in the non-responders may account for their poor response to CRT.
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